Open Access Open Access  Restricted Access Subscription Access

CLINICAL STUDY OF FISTULA-IN-ANO AND ANALYSIS OF VARIOUS TREATMENT MODALITIES

Amar Sharma, S. P. Mukhiya, Sabir Husain, Umesh Jethwani

Abstract


Introduction: Fistula in ano is common surgical condition that is treated by different surgical modalities.

Objective: To Study aetiopathogenesis and clinical presentation of Fistula-in-ano. To determine the predictive accuracy of Goodsal’s law. To study the various modes of treatment. To study outcomes of different modalities in follow up.

Material and Methods: A prospective study was done on 100 patients of fistulae in ano who were admitted to the surgical department at C.R. Gardi Hospital, Ujjain from 1st September 2012 to 31st June 2014. Fistulotomy was done in 53% of patients, and fistulectomy was done in 43% of patients and seton done in 4% of patients. Patients were followed up post operatively for Six months and the healing time was estimated in all patients and complication rate was recorded including bleeding, infection, incontinence and recurrence.

Results: Out  of  100  patients  included  in  this  study, most common age of presentation is 31-40 years and more common in male then females (M:F = 4:1). 76% of patient have history of perianal abscess out of them 32% of patients had history  of  I & D of perianal abscess and, rest of the patient give history of several episode of abscess formation which burst or discharged spontaneously. The  complications  which  were  recorded  include  bleeding  occurred  in  only  14% out of  53% of  patients  following fistulectomy, in 6% of patients out of 43% of bleeding developed following fistulotomy, 62% of patients followed Goodsall’s law and 38% of patients did not follow Goodsall’s law. Goodsall’s law is accurate in 62% of anterior external opening and 60% of posterior external opening. Infection  developed  in  one  case 4 out  of  53 following  fistulotomy  and  12  case  out  of  43 following fistulectomy. Fistulotomy wound heals faster than fistulectomy and seton in for high level fistula

Conclusion: Fistulotomy can be used as a primary treatment of fistula in ano as the operating time is shorter and it takes shorter period of time for the wound to heal and the incidence of complications is comparable to that of fistulectomy.

Keywords


Fistula, Fistula-in-ano, Fistulectomy, Aetiopathogenesis, Seton, Fistulotomy.

Full Text:

PDF

References


Ani AN, and Solanke TF. (1976). “Anal Fistula: A Review of 82 cases”, Dis Colon Rectum, Vol.19, p.51.

Barwood et al. (1997). “Fistula-in-ano: A prospective Study of 107 patients”, Aus NVJ Surg, Feb-March, Vol.67(2-3), pp.98-102.

Bruhl S. (1986). “Perianal fistulae. Part A: survey”, Coloproctology, Vol.8, pp.109-114.

Buchanan GN, Hallingan S, Bartram CI, and Williams AB, et al. (2004). “Clinical Examination, Endosonography, and MR Imaging in Preoperative Assessment of Fistula in Ano: Comparison with Outcome-based Reference Standard1”, Radiology, Vol.233, pp.674-681.

Dunn KMB, and Rothenberger DA. (2010). “Colon, Rectum, and Anus”, Schwartz,s Principles of Surgery, 9th Edition, Mc Graw Hill, Vol.29, p.1064.

Eisenhammer S. (1985). “Emergency fistulectomy of the acute primary anorectal cryptoglandular intermuscular abscess-fistula in ano”, S Afr J Surg, Vol.23, pp.1-7.

Farquharson M, Breharson, and Moran B. (2005). “Surgery of the anus and the perineum”, Rintoul RF. “Farquharsons textbook of operative general surgery”, 9th Edition, Edward Arnold, Vol.23, pp.445-453.

Hirranyakas N, Maipang T, and Greater A. (2005). “Assessment of anal fistulas using endo-anal ultrasound”, Songkla Med J, Vol.23(5), pp.357-361.

Kuypres JH. (1982). “Diagnosis and treatment of fistula in ano”, Neth J.surg, Vol.34, pp.147-152.

KW EU. (1992). “Fistulotomy and marsupialization for simple fistula-in-ano”, Singapore Med J, Vol.33, p.532.

Lunniss PJ. (2008). “The anus and the anal canal”, Williams NS, Bulstrode CJK, and O`Connell PR. “Bailey and love’s Short Practice of Surgery”, 25th Edition, Edward Arnold, Vol.69, pp.1262-1264.

Lunniss PJ, Barker PG, and Sultan AH, et al. (1994). “Magnetic resonance imaging of fistula in ano”, Dis Colon Rectum, Vol.37, pp.708-718.

Marks CG, and Ritchie JK. (1977). “Anal fistulae at St. Mark's Hospital”, Br J Surg, Vol.64, pp.84-91.

Parks AG, Gardon PH, and Hardcastle JD. (1976). “A Classification of fistula-in-ano”, Br J Surg, Vol.63, pp.1-12.

Sainio P. (1984). “Fistula-in-ano in a defined population. Incidence and epidemiological aspects”, Ann Chir Gynaecol, Vol.73(4), pp.219-224.

Vasilevsky CA. (1992). “Fistula in ano and abscess”, in, Beck DE, and Wexner SD. (eds). Fundamentals of anorectal surgery, pp.131-144.

Vasilevsky CA, and Gordon PH. (1984). “The incidence of recurrent abscesses or fistula-in-ano following anorectal suppuration”, Dis Colon Rectum, Vol.27, pp.126–130.


Refbacks

  • There are currently no refbacks.


Send mail to ijsss@ijsss.com with questions or comments about this web site. 

International Journal of Surgery and Surgical Sciences, All rights reserved.